Fix a Dislocated Shoulder

Dislocated joints, particularly of the shoulder, are painful injuries that cause immediate short-term disability — movement of the joint is essentially impossible until it's relocated or reset. The shoulder is especially vulnerable to dislocation because it's the most mobile joint in the body and people tend to fall with an outstretched arm, which puts the joint in an awkward position. It's always best to have a dislocated shoulder fixed or reset by a trained health professional, although there may be unusual (emergency) circumstances that warrant trying to do it yourself. Not resetting a dislocated shoulder in a timely fashion may eventually necessitate surgery to properly fix it.

Steps

Dealing with a Dislocated Shoulder

1. Recognize the symptoms. A dislocated shoulder is usually caused by either falling onto an outstretched arm or the shoulder being impacted from behind. The injury causes sudden and severe pain, preceded by a popping feeling and/or sound. The shoulder will look visibly deformed or out-of-place, and swelling and bruising appear quickly. Moving the shoulder is not possible until it is relocated.
   • A dislocated shoulder hangs lower than the uninjured side and you can usually see a depression or groove in the lateral (deltoid) muscle of the shoulder.
   • A shoulder dislocation may also cause numbness, tingling and/or weakness down the arm and into the hand. If blood vessels are damaged, the lower arm and hand on the injured side will feel cold and turn a bluish color.
   • About 25% of first-time shoulder dislocations involve fractures of the upper arm (humerus) or shoulder girdle.
2. Immobilize your arm. While you're waiting to get medical attention, it's important to not move (or attempt to move) a dislocated shoulder because you may make the injury worse. A bone fracture, damaged nerve or ripped blood vessel may be involved, so any movement could have dire consequences. Instead, bend your elbow, wrap your forearm around your stomach area and hold it in position with a sling.
   • If you don't have access to a ready-made sling, then make one from a pillow case or article of clothing. Put the sling under your elbow/forearm and tie the ends around your neck. Slings immobilize and protect the shoulder from further injury, and often greatly reduce the degree of pain.
   • About 95% of shoulder dislocations are in the anterior direction, which means the upper arm bone (humerus) is pushed forward out of its socket.
3. Ice your shoulder. Getting ice or something cold onto a dislocated shoulder joint as soon as possible is important in order to inhibit inflammation, which usually translates into less pain. Ice causes small blood vessels to constrict (narrow), which limits the amount of blood and inflammation that can flow into and around the injured area. Apply the crushed ice to the shoulder for about 15 – 20 minutes at a time (or until the area feels numb) every hour or so.
   • Always wrap ice in a thin cloth, towel or plastic bag before applying it to bare skin — it'll help prevent frostbite or skin irritation.
   • If you don't have access to crushed ice or ice cubes, then use some frozen veggies from the freezer or a frozen gel pack.
4. Take pain medications. Once the dislocated shoulder is immobilized and covered in a bag of ice, consider taking some over-the-counter medication to further combat the inflammation and pain. The pain from a dislocated shoulder is often described as almost unbearable due to all the stretched and/or torn ligaments, tendons and muscles that occur, in addition to potential bone fractures and cracked cartilage. Ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) are likely the best choices because they are strong anti-inflammatories, although acetaminophen (Tylenol) can be helpful for pain control also.
   • For a dislocated shoulder that also involves significant internal bleeding (you'll see lots of bruising), avoid ibuprofen and naproxen because they tend to "thin" the blood and reduce its clotting ability.
   • A muscle relaxant medication might also be indicated if the muscles around the dislocated joint are spasming. However, never mix different types of drugs concurrently — pick one or the other.

Relocating in Emergency Situations

1. Relocate your shoulder only in emergency situations. Under most situations, waiting for professional medical help is the best idea and certainly the safest way to go, but sometimes that's not possible. If you're in an isolated situation far from medical attention (camping, mountain climbing, traveling abroad), the potential risks of fixing your own shoulder — or that of a friend or family member — may not outweigh the benefits of experiencing immediate pain relief and increased arm/shoulder mobility.
   • As a general rule of thumb, if you can get medical assistance within 12 hours, then wait patiently and try to reduce the discomfort with ice, painkillers and a sling. If a much longer waiting time is apparent, particularly if you need some mobility in your shoulder to get to a hospital, then relocating your shoulder might be considered.
   • The main complications related to trying to relocate your own shoulder are: further tearing muscles, ligaments and tendons; damaging nerves and blood vessels; life-threatening bleeding; severe pain that results in loss of consciousness.
2. Ask for help in an emergency situation. If you're forced to consider relocating your own shoulder in an emergency situation, then realize that putting it back in without assistance is nearly impossible. As such, ask for help or offer to help someone else if in an emergency situation. People may be reluctant to help you because they don't want to cause you more pain or risk injuring your shoulder more, so try to reassure them and release them from any liability.
   • If you're needed to help someone else relocate his shoulder, make sure to get his consent and tell him clearly about your lack of medical training (if applicable). You don't want to face any litigation for trying to be helpful if things go wrong.
   • If you have a phone and can make a call, try contacting emergency services for advice and support. Even if they can't send medical personnel to you right away, they may be able to offer helpful instructions.
3. Lay on your back and abduct your arm. Probably the easiest way for non-professionals to relocate your shoulder joint is if you lay flat on your back with your injured arm away from your body at a 90 degree angle. Then get your friend or a bystander to firmly grab your hand or wrist and slowly (but firmly) pull on your arm, which will create traction. The person may have to position her feet against your torso for additional leverage. Pulling the arm at that angle allows the head of the humerus to slide under the bone of your shoulder blade and back into its socket with relative ease.
   • Remember to use a slow, steady pull (without any fast or jerky movements) directly away from the body until the shoulder re-articulates. If it successful, you will hear a "clunk" and feel the shoulder get back into position.
   • As soon as the shoulder relocates, the level of pain associated with the injury will reduce significantly. However, the shoulder will still be unstable, so make a sling and immobilize the arm if possible.

Getting Medical Attention

1. See a doctor as soon as you can. Getting to a doctor (or an appropriately trained medical professional) quickly is important when dealing with a dislocated shoulder because when the muscles, tendons and ligaments around the injury tighten up, the head of the humerus becomes very difficult to relocate without surgical intervention. Most doctors will likely want to x-ray your shoulder area before doing anything else in order to rule out a fracture.
   • If nothing is broken or badly torn, then the doctor can perform a closed reduction maneuver on the shoulder joint, although you may need a sedative, strong muscle relaxant or general anesthetic before the physical manipulation can be done due to the severe pain.
   • A common reduction method for the shoulder joint is called the Hennepin maneuver, which utilizes external rotation of the shoulder. While laying flat, the doctor will flex your elbow to 90 degrees and gradually rotate your shoulder outward (external rotation). Some gentle pushing while in this position is usually enough for the joint to relocate.
   • There are a handful of other reduction techniques that doctors use — it depends on what they feel comfortable with.
2. Prepare yourself for the possibility of surgery. If your shoulder is regularly dislocating (due to a bone deformity or ligament laxity), or if any bones are fractured or nerves and/or blood vessels ripped, then you'll need surgery to repair the damage and have the shoulder joint reduced openly. Surgery is sometimes the best option because it can fix internal damage and stabilize the joint, which greatly reduces the risk of dislocation in the future.
   • There are many different surgical procedures that are performed, so it depends on the extent of the damage and the patient's lifestyle/activity level as to which technique is used.
   • Some studies suggest that surgical "open" reduction may be the best course of action for active adults younger than 30 years due to lower recurrence rates and better quality of life outcomes.
3. Rehabilitate your shoulder. Regardless if you get a closed manual reduction or an open surgical reduction, you should get a referral for physiotherapy and strengthen your shoulder joint. Physical therapists, chiropractors and/or athletic therapists can show you specific stretches to regain full mobility and range of motion in your shoulder, as well as exercises that strengthen and tighten the joint so that it's unlikely to dislocate in the future.
   • It often takes two to four weeks of recovery before a referral to physical therapy is appropriate. Wearing a sling, applying ice and taking over-the-counter medications is all part of the recovery phase.
   • The total time to rehabilitate and recover from a shoulder dislocation ranges from three to six months, depending on the severity of injury and if the patient is an athlete or not.

Tips

• After a few days when the pain / inflammation have ceded, applying some moist heat to your shoulder might help relax the tight and sore muscles. Microwavable herbal bags work well. However, limit heat applications to 15 – 20 minutes at a time.
• Once you've dislocated your shoulder joint once, you become more at risk of future dislocations, especially if you participate in contact sports.
• Relocate your shoulder as soon after the accident as you are able, as difficulty relocating it increases with time.
• A dislocated shoulder is different than a separated shoulder. The latter is a ligament sprain to the joint that holds the collarbone (clavicle) to the front part of the shoulder girdle — the glenohumeral joint is not dislocated.

Warning

• After relocating a dislocated shoulder, you should always check the pulse in the affected limb below the site of the dislocation. It should be the same as the other arm (unaffected limb). If there is a slower pulse or no pulse, then it's a medical emergency and requires immediate assistance, as cell death begins quickly and could result in loss of the arm.

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